【歌】妇人带下为何因？风寒气热乘胞门。精气累滞于带脉，因而带下得其名。湿痰下注或湿热，赤白
须将气血分。
【论】夫带下者，由湿痰流注于带脉而下浊液，故曰带下。良方以为起于风气寒热之所伤；或不避风邪，
入于胞门；或中经脉，留传脏腑而发；或伤于五脏，而见五色之带。但专用燥热治之，其谬甚矣。机要以赤者
热入小肠，白者热入大肠，其本实热郁结不散，则为赤白带下，多用寒凉攻下之剂。东垣以血少复亡其阳，故
白滑之物下流；亦有湿痰流注于下焦；或肾、肝阴淫之湿胜；或缘惊恐而木乘土位，浊液下流；或思慕为筋痿，
所谓二阳病也，多用补剂而兼升提。丹溪专主湿热下注，故以化痰而兼止涩之剂。古人立论，殆尽病情，而治
法无定，后学弗知所措，不能无疑。大抵属痰与热者居多，阴寒者十无一、二。学人仍须精察虚、实、迟、数
之脉，细审寒、热、湿、痰之证，治之斯无执一之患也。
【脉】带下崩中，脉多浮动，虚迟者轻，实数者重。
寒
白带腥臭，多悲不乐者，寒也，阳气极虚，桂附汤。妇人赤白带下，脉息沉微，腹痛，阴中亦痛，经水愆
期，子宫虚冷，不能成孕者，元戎六合汤。
桂附汤
治妇人白带腥臭，多悲不乐，大寒之证。
肉桂（一钱） 附子（炮，三钱） 知母（酒炒，五分） 黄柏（盐、酒炒，五分） 甘草（炙，五分）
升麻（五分） 人参（七分） 黄 （蜜炙，一钱五分）
上锉，一剂，水二盏，煎八分，食前温服。
元戎六合汤
治妇人带下，腹中疼痛，阴中亦痛。
即四物汤（四钱，见前经候条。）加肉桂、附子（各五分）
食前煎服。
虚
白带久不止，脐腹冷痛，阴中亦痛，经水不止，或因崩后，脉弱无力，酸痛，东垣固真丸。产后去血
过多，经水不调，白带如倾，淋沥腥秽，卫生汤。
东垣固真丸
治白带久不止，脐腹冷疼，阴中亦然。
白石脂（烧赤，一钱，另研） 柴胡（酒制，一钱） 黄柏（去皮，酒炒，一钱） 当归身（二钱） 白芍药
（一钱） 干姜（炮，四钱） 白龙骨（ ，二钱，另研）
上为细末，水煮糊丸如梧桐子大，每十丸，空心下。
卫生汤
治带下不止，脉微而弱，脐腹疼痛。
白芍药（三两） 当归身（三两） 黄 （蜜炙，三两） 甘草（一两）
上锉，一剂，水二盏，煎至八分，空心服。
热
内热脉数，赤白带下不止，枸杞根一两、生地黄五两、酒一斗，煮至三升服。赤白带，内火盛，阴虚烦热，
二黄三白丸益母草末酒调服，或白芷散。
二黄三白丸
治白带，因七情所伤而脉数者。
扁 （酒蒸，五钱） 黄柏（炒，五钱） 香附（醋炒，一两） 白芍药（炒，一两） 白术（炒，一两）
黄连（炒，五钱） 椿皮（炒，二两） 白芷（ 存性，
二两）
上为末，粥丸如梧桐子大，每服七十丸，米汤送下。
白芷散
治女人赤白带下，火热内盛。
白芷（一两） 胎发（一团， ） 海螵蛸（二枚， ）
为末，酒送下。
湿痰
湿痰结注于下，白带淋漓，先以小胃丹开导闭郁，后用白术丸。湿痰下注，半夏、南星、海石、炒黄柏、
苍术、樗根皮、青黛、香附、滑石、蛤粉、陈皮、茯苓。
小胃丹
取膈上湿痰热积，以意消息之。欲利，空心服。
芫花（半两，好醋拌一宿，瓦器内炒，不住手搅，令黑不要焦） 甘遂（半两，湿面裹，长流水浸半月，再
用水煮，晒干） 大戟（半两，长流水煮一时，再用水洗，晒干） 大黄（一两半，湿纸裹煨勿令焦，切片焙干，
再用酒润，炒熟） 黄柏（三两，炒褐色）
为细末，粥丸如麻子大，白汤送下。
白术丸
治赤白带，先以小胃丹开导，后用此补之。
白术（二两，炒） 黄芩（五钱） 白芍药（七钱） 红白葵花（二钱半）
上为极细末，蒸饼糊丸，空心，煎四物汤下五十丸。
湿热
肥人白带，阴户痛，身黄，皮缓身重，阴中如水湿也，升阳燥湿汤。湿而挟热者，大便或泄或闭，小便涩，
脉实而气盛，湿热者，十枣汤下之。
升阳燥湿汤
治白带阴中痛，身重如山，身黄皮缓。
黄芩（炒，一钱） 柴胡（八分） 防风（一钱，去芦） 甘草（六分） 陈皮（八分） 良姜（一钱） 干姜
（一钱） 郁李仁（一钱） 白葵花（七朵）
锉一剂，水二钟，煎至八分，空心服。
十枣汤
治湿痰猛烈之剂，用之者，当以意消息。
甘遂（五分） 大戟（五分） 芫花（五分） 枣（十枚）
上，用水二钟，煎八分温服，以利为度。
【歌诀】
妇女带下病是什么原因造成的？是因为风、寒、气、热邪气侵袭了胞宫之门。精气在带脉中积聚阻滞，因此产生了带下病，并由此得名。若是湿痰下注或湿热蕴结，必须根据赤带和白带来区分气血的病变。
【论述】
所谓带下病，是由于湿痰流注于带脉，导致浊液向下流出，所以称为带下。《良方》认为此病起于风气、寒热等外邪的伤害；或者是不避风邪，风邪侵入胞门；或者邪气进入经脉，留传至脏腑而发病；或者损伤五脏，出现五色带下。如果仅仅专门使用燥热药物治疗，那就大错特错了。《机要》认为赤色带下是热邪侵入小肠，白色带下是热邪侵入大肠，其根本原因是实热郁结不散，从而形成赤白带下，治疗多用寒凉攻下的方剂。李东垣认为血虚又亡阳，导致白滑之物下流；也有因湿痰流注于下焦；或者是肾、肝阴分湿气过盛；或者因为惊恐导致肝木乘克脾土，浊液下流；或者因为思慕过度导致筋痿，即所谓的“二阳病”，治疗多用补益剂兼以升提。朱丹溪专门主张湿热下注，因此治疗以化痰兼用止涩的方剂。古人立论，几乎穷尽了病情，但治疗方法没有定法，后学者不知道如何处置，不能不产生疑问。大体上属于痰与热的居多，属于阴寒的十无一、二。学习者仍然必须仔细诊察虚、实、迟、数的脉象，细致审辨寒、热、湿、痰的证候，这样治疗才不会犯固执一端的错误。
【脉诊】
带下病和崩漏病，脉象多表现为浮或动。脉象虚迟的病情较轻，脉象实数的病情较重。
【寒证】
白带腥臭，情绪悲伤不乐，这是寒证，阳气极度虚弱，用桂附汤（Cinnamon Twig and Aconite Decoction）。妇人赤白带下，脉象沉微，腹痛，阴部也痛，月经延期，子宫虚冷，不能受孕的，用元戎六合汤（Yuanrong Liuhe Decoction）。
桂附汤
治疗妇人白带腥臭，情绪悲伤不乐，属于大寒证。
肉桂（Guizhi, 1 qian） 附子（Fuzi, processed, 3 qian） 知母（Zhimu, wine-fried, 0.5 qian） 黄柏（Huangbai, salt- and wine-fried, 0.5 qian） 甘草（Gancao, roasted, 0.5 qian）
升麻（Shengma, 0.5 qian） 人参（Renshen, 0.7 qian） 黄芪（Huangqi, honey-roasted, 1.5 qian）
以上药材切碎，一剂药，加水两盏，煎至八分，饭前温服。
元戎六合汤
治疗妇人带下，腹中疼痛，阴部也痛。
即四物汤（Sijunzi Tang, 4 qian, see previous menstruation section）加肉桂（Guizhi）、附子（Fuzi）（各0.5 qian）
饭前煎服。
【虚证】
白带久治不止，脐腹部冷痛，阴部也痛，月经淋漓不止，或者因崩漏之后，脉弱无力，酸痛，用东垣固真丸（Dongyuan Guzhen Wan）。产后失血过多，月经不调，白带如倾泻般流出，淋漓腥秽，用卫生汤（Weisheng Tang）。
东垣固真丸
治疗白带久治不止，脐腹部冷痛，阴部亦然。
白石脂（Baishizhi, calcined red, 1 qian, ground separately） 柴胡（Chaihu, wine-processed, 1 qian） 黄柏（Huangbai, peeled, wine-fried, 1 qian） 当归身（Dangguishen, 2 qian） 白芍药（Baishao, 1 qian） 干姜（Ganjiang, processed, 4 qian） 白龙骨（Bailonggu, processed, 2 qian, ground separately）
以上研为细末，用水煮糊制作成梧桐子大小的丸药，每次十丸，空腹服用。
卫生汤
治疗带下不止，脉象微而弱，脐腹疼痛。
白芍药（Baishao, 3 liang） 当归身（Dangguishen, 3 liang） 黄芪（Huangqi, honey-roasted, 3 liang） 甘草（Gancao, 1 liang）
以上切碎，一剂药，加水两盏，煎至八分，空腹服用。
【热证】
内热脉数，赤白带下不止，用枸杞根（Gouqigen）一两、生地黄（Shengdihuang）五两、酒一斗，煮至三升服用。赤白带，内火旺盛，阴虚烦热，用二黄三白丸（Erhuang Sanbai Wan）配合益母草末（Yimucao Mo），酒调服，或者用白芷散（Baizhi San）。
二黄三白丸
治疗白带，因七情所伤而脉数的情况。
扁豆（Biandou, wine-steamed, 5 qian） 黄柏（Huangbai, fried, 5 qian） 香附（Xiangfu, vinegar-fried, 1 liang） 白芍药（Baishao, fried, 1 liang） 白术（Baizhu, fried, 1 liang）
黄连（Huanglian, fried, 5 qian） 椿皮（Chunpi, fried, 2 liang） 白芷（Baizhi, charred but retaining nature, 2 liang）
以上研为末，用米粥糊制作成梧桐子大小的丸药，每次七十丸，米汤送服。
白芷散
治疗女人赤白带下，火热内盛。
白芷（Baizhi, 1 liang） 胎发（Taifa, one tuft, charred） 海螵蛸（Haipiaoxiao, two pieces, charred）
研为末，酒送服。
【湿痰】
湿痰结聚注于下部，白带淋漓，先用小胃丹（Xiaowei Dan）开通导滞闭郁，后用白术丸（Baizhu Wan）。湿痰下注，可用半夏（Banxia）、南星（Nanxing）、海浮石（Haishi）、炒黄柏（Chao Huangbai）、苍术（Cangzhu）、樗根皮（Chugenpi）、青黛（Qingdai）、香附（Xiangfu）、滑石（Huashi）、蛤粉（Gafen）、陈皮（Chenpi）、茯苓（Fuling）。
小胃丹
去除膈上的湿痰热积，需酌情使用。想要通便，空腹服用。
芫花（Yuanhua, half liang, mixed with good vinegar overnight, fried in a clay vessel while stirring constantly until black but not burnt） 甘遂（Gansui, half liang, wrapped in wet dough, soaked in running water for half a month, then boiled in water, dried） 大戟（Daji, half liang, boiled in running water for one hour, then washed with water, dried） 大黄（Dahuang, one and a half liang, wrapped in wet paper and baked until not burnt, sliced and dried, then moistened with wine and fried cooked） 黄柏（Huangbai, three liang, fried until brown）
研为细末，用粥糊制作成麻子大小的丸药，白开水送服。
白术丸
治疗赤白带，先用小胃丹开通导滞，后用此药补益。
白术（Baizhu, two liang, fried） 黄芩（Huangqin, five qian） 白芍药（Baishao, seven qian） 红白葵花（Hongbai Kuihua, two and a half qian）
以上研为极细末，用蒸饼糊制作丸药，空腹时，用四物汤（Sijunzi Tang）送服五十丸。
【湿热】
肥胖之人白带，阴户痛，身体发黄，皮肤松弛身体沉重，阴中有如水湿感，用升阳燥湿汤（Shengyang Zaoshi Tang）。湿而挟热者，大便或泄或闭，小便涩，脉实而气盛，湿热证，用十枣汤（Shizao Tang）攻下。
升阳燥湿汤
治疗白带阴中痛，身体重如山，身体发黄皮肤松弛。
黄芩（Huangqin, fried, 1 qian） 柴胡（Chaihu, 0.8 qian） 防风（Fangfeng, 1 qian, remove radix） 甘草（Gancao, 0.6 qian） 陈皮（Chenpi, 0.8 qian） 良姜（Liangjiang, 1 qian） 干姜（Ganjiang, 1 qian） 郁李仁（Yuliren, 1 qian） 白葵花（Baikuihua, seven flowers）
切碎一剂，加水两钟，煎至八分，空腹服用。
十枣汤
治疗湿痰猛烈的方剂，使用者需酌情掌握。
甘遂（Gansui, 0.5 qian） 大戟（Daji, 0.5 qian） 芫花（Yuanhua, 0.5 qian） 大枣（Dazao, ten pieces）
以上（药材处理），加水两钟，煎至八分，温服，以通利为度。
[Song]
What is the cause of leukorrhea in women? It arises when wind, cold, qi stagnation, or heat pathogens invade the gate of the uterus (Baomen). When essence and qi accumulate and stagnate in the Dai Mai (Girdle Vessel), leukorrhea occurs, hence its name. If damp-phlegm flows downward or damp-heat accumulates, one must distinguish between blood and qi based on whether the discharge is red or white.
[Dissertation]
Leukorrhea refers to the flow of turbid fluid downward due to damp-phlegm flowing into the Dai Mai (Girdle Vessel), thus it is called leukorrhea. *Liangfang* states that it originates from injury by wind, cold, or heat pathogens; or from failing to avoid wind pathogens, allowing them to enter the Baomen (gate of the uterus); or entering the meridians, lingering and transmitting to the zang-fu organs to manifest; or injuring the five zang organs, resulting in leukorrhea of five colors. However, using only drying and warming treatments is a grave error. *Jiyao* posits that red discharge indicates heat invading the Small Intestine, and white discharge indicates heat invading the Large Intestine; the root cause is actual heat stagnation and accumulation that does not dissipate, leading to red-and-white leukorrhea, which is often treated with cold and purgative formulas. Li Dongyuan argued that blood deficiency combined with loss of yang leads to the flow of white, slippery substances; there are also cases of damp-phlegm flowing into the lower jiao; or excessive yin-dampness from the Kidney and Liver; or due to fright causing Wood to overact on Earth (Liver overacting on Spleen/Stomach), leading to turbid fluid flow; or due to excessive longing causing sinew atrophy, known as "diseases of the Two Yangs," which are mostly treated with tonifying agents combined with lifting methods. Zhu Danxi specifically emphasized damp-heat flowing downward, thus treating with phlegm-resolving agents combined with astringents. The ancients' theories almost exhaustively described the conditions, but treatment methods were not fixed, leaving later learners unsure how to proceed and full of doubts. Generally, cases belong mostly to phlegm and heat, while those belonging to yin-cold account for only one or two out of ten. Learners must still carefully examine the pulse for deficiency, excess, slow, or rapid qualities, and meticulously assess the syndromes of cold, heat, dampness, and phlegm; only then can treatment avoid the pitfall of rigid adherence to a single method.
[Pulse Diagnosis]
For leukorrhea and metrorrhagia (Bengzhong), pulses are often floating or moving. A deficient and slow pulse indicates mild disease, while an excess and rapid pulse indicates severe disease.
[Cold Syndrome]
White discharge with a fishy odor, accompanied by sadness and unhappiness, indicates Cold syndrome due to extreme deficiency of Yang Qi; treat with Guizhi Tang (Cinnamon Twig Decoction). For women with red-and-white leukorrhea, deep and faint pulse, abdominal pain, vulvar pain, delayed menstruation, uterine deficiency-cold, and infertility, treat with Yuanrong Liuhe Tang (Yuanrong Six Harmonies Decoction).
Guizhi Tang (Cinnamon Twig and Aconite Decoction)
Treats women's leukorrhea with fishy odor, sadness, and unhappiness, indicating a severe Cold syndrome.
Guizhi (Cinnamon Twig, 1 qian) Fuzi (Aconite Root, processed, 3 qian) Zhimu (Anemarrhena Rhizome, wine-fried, 0.5 qian) Huangbai (Phellodendron Bark, salt- and wine-fried, 0.5 qian) Gancao (Licorice Root, roasted, 0.5 qian)
Shengma (Cimicifuga Rhizome, 0.5 qian) Renshen (Ginseng Root, 0.7 qian) Huangqi (Astragalus Root, honey-roasted, 1.5 qian)
Decoct these ingredients together. One dose with two cups of water, decocted to eight-tenths. Take warm before meals.
Yuanrong Liuhe Tang (Yuanrong Six Harmonies Decoction)
Treats women's leukorrhea with abdominal pain and vulvar pain.
This is Sijunzi Tang (Four Substances Decoction, 4 qian, see previous section on menstruation) plus Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) (each 0.5 qian).
Decoct and take before meals.
[Deficiency Syndrome]
Long-standing leukorrhea that does not stop, cold pain in the umbilical and abdominal region, vulvar pain, continuous menstruation, or following metrorrhagia, with a weak and powerless pulse, soreness, and pain, treat with Dongyuan Guzhen Wan (Dongyuan Solidify Truth Pill). Postpartum excessive blood loss, irregular menstruation, leukorrhea pouring like a flood, dripping with foul smell, treat with Weisheng Tang (Health Preservation Decoction).
Dongyuan Guzhen Wan (Dongyuan Solidify Truth Pill)
Treats long-standing leukorrhea that does not stop, cold pain in the umbilical and abdominal region, and similar pain in the vulva.
Baishizhi (Halloysitum Rubrum, calcined red, 1 qian, ground separately) Chaihu (Bupleurum Root, wine-processed, 1 qian) Huangbai (Phellodendron Bark, peeled, wine-fried, 1 qian) Dangguishen (Angelica Sinensis Root Body, 2 qian) Baishao (White Peony Root, 1 qian) Ganjiang (Dried Ginger, processed, 4 qian) Bailonggu (Fossilized Bone, processed, 2 qian, ground separately)
Grind into fine powder, make pills with water-boiled paste the size of paulownia seeds. Take ten pills on an empty stomach.
Weisheng Tang (Health Preservation Decoction)
Treats persistent leukorrhea with a faint and weak pulse, and umbilical/abdominal pain.
Baishao (White Peony Root, 3 liang) Dangguishen (Angelica Sinensis Root Body, 3 liang) Huangqi (Astragalus Root, honey-roasted, 3 liang) Gancao (Licorice Root, 1 liang)
Decoct one dose with two cups of water to eight-tenths. Take on an empty stomach.
[Heat Syndrome]
Internal heat with a rapid pulse, persistent red-and-white leukorrhea: decoct Gouqigen (Goji Root Bark, 1 liang), Shengdihuang (Rehmannia Root, fresh, 5 liang) in one dou of wine until reduced to three sheng. For red-and-white leukorrhea with strong internal fire, yin deficiency with vexatious heat, take Erhuang Sanbai Wan (Two Yellows Three Whites Pill) mixed with Yimucao Mo (Motherwort Powder), taken with wine, or use Baizhi San (Angelica Dahurica Powder).
Erhuang Sanbai Wan (Two Yellows Three Whites Pill)
Treats leukorrhea caused by emotional injury with a rapid pulse.
Biandou (Lablab Seed, wine-steamed, 5 qian) Huangbai (Phellodendron Bark, fried, 5 qian) Xiangfu (Cyperus Rhizome, vinegar-fried, 1 liang) Baishao (White Peony Root, fried, 1 liang) Baizhu (Atractylodes Macrocephala Rhizome, fried, 1 liang)
Huanglian (Coptis Rhizome, fried, 5 qian) Chunpi (Toona Bark, fried, 2 liang) Baizhi (Angelica Dahurica Root, charred but retaining nature, 2 liang)
Grind into powder, make pills with congee paste the size of sesame seeds. Take seventy pills per dose, delivered with rice soup.
Baizhi San (Angelica Dahurica Powder)
Treats women's red-and-white leukorrhea with intense internal heat.
Baizhi (Angelica Dahurica Root, 1 liang) Taifa (Human Placenta Hair/Fetal Hair, one tuft, charred) Haipiaoxiao (Cuttlefish Bone, two pieces, charred)
Grind into powder, take with wine.
[Damp-Phlegm]
Damp-phlegm accumulating and flowing downward causes dripping leukorrhea. First use Xiaowei Dan (Minor Stomach Pill) to open and guide the obstruction, then use Baizhu Wan (Atractylodes Pill). For damp-phlegm flowing downward, use Banxia (Pinellia Tuber), Nanxing (Arisaema Rhizome), Haishi (Floating Limestone), Chao Huangbai (Fried Phellodendron Bark), Cangzhu (Atractylodes Lancea Rhizome), Chugenpi (Toona Root Bark), Qingdai (Indigo Naturalis), Xiangfu (Cyperus Rhizome), Huashi (Talcum), Gafen (Clam Shell Powder), Chenpi (Citrus Reticulata Peel), Fuling (Poria).
Xiaowei Dan (Minor Stomach Pill)
Removes damp-phlegm and heat accumulation in the diaphragm; use discretion. To induce purgation, take on an empty stomach.
Yuanhua (Kadsura Flower Bud, half liang, mixed with good vinegar overnight, fried in a clay vessel while stirring constantly until black but not burnt) Gansui (Euphorbia Lathyris Root, half liang, wrapped in wet dough, soaked in running water for half a month, then boiled in water, dried) Daji (Euphorbia Pekinensis Root, half liang, boiled in running water for one hour, then washed with water, dried) Dahuang (Rhubarb Root, one and a half liang, wrapped in wet paper and baked until not burnt, sliced and dried, then moistened with wine and fried cooked) Huangbai (Phellodendron Bark, three liang, fried until brown)
Grind into fine powder, make pills the size of sesame seeds with congee paste. Take with plain water.
Baizhu Wan (Atractylodes Pill)
Treats red-and-white leukorrhea; first use Xiaowei Dan to open and guide, then use this formula to tonify.
Baizhu (Atractylodes Macrocephala Rhizome, two liang, fried) Huangqin (Scutellaria Root, five qian) Baishao (White Peony Root, seven qian) Hongbai Kuihua (Red and White Hibiscus Flowers, two and a half qian)
Grind into extremely fine powder, make pills with steamed bread paste. Take fifty pills on an empty stomach, delivered with Sijunzi Tang (Four Substances Decoction).
[Damp-Heat]
In obese individuals, leukorrhea with vulvar pain, yellow body complexion, loose skin, heavy body, and a sensation of water-dampness in the vagina: treat with Shengyang Zaoshi Tang (Raise Yang Dry Dampness Decoction). For dampness combined with heat, where stool is either loose or constipated, urine is scanty/astringent, pulse is excess and qi is vigorous, treat damp-heat with Shizao Tang (Ten Jujube Decoction) to purge.
Shengyang Zaoshi Tang (Raise Yang Dry Dampness Decoction)
Treats leukorrhea with vulvar pain, body heaviness like carrying a mountain, yellow body complexion, and loose skin.
Huangqin (Scutellaria Root, fried, 1 qian) Chaihu (Bupleurum Root, 0.8 qian) Fangfeng (Saposhnikovia Root, 1 qian, remove radix) Gancao (Licorice Root, 0.6 qian) Chenpi (Citrus Reticulata Peel, 0.8 qian) Liangjiang (Galangal Rhizome, 1 qian) Ganjiang (Dried Ginger, 1 qian) Yuliren (Bush Cherry Kernel, 1 qian) Baikuihua (White Hibiscus Flower, seven flowers)
Decoct one dose with two zhong of water to eight-tenths. Take on an empty stomach.
Shizao Tang (Ten Jujube Decoction)
A potent formula for severe damp-phlegm; users must exercise discretion.
Gansui (Euphorbia Lathyris Root, 0.5 qian) Daji (Euphorbia Pekinensis Root, 0.5 qian) Yuanhua (Kadsura Flower Bud, 0.5 qian) Dazao (Jujube Fruit, ten pieces)
Decoct these ingredients with two zhong of water to eight-tenths. Take warm. Stop when purgation occurs.